Medicare Primary or Secondary Health Insurance Coverage
Part 3, Chapter 9: Medicare and Medicare Related Programs: Medicare Page 7
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In addition, there is an enormous amount of confusion concerning the question of whether Medicare represents a beneficiary's primary or secondary insurer in situations in which the beneficiary's spouse is covered by an employer-sponsored group health insurance plan. Eliminating that confusion would help many Medicare beneficiaries make sense of the claim-processing system, and might help save a great deal of money.
Under current rules, if the spouse of a Medicare beneficiary is working, and is covered by an employer-sponsored group health insurance plan, the question of whether Medicare is primary or secondary for the Medicare beneficiary depends on three factors: The number of employees in the spouse's company, the age of the Medicare beneficiary, and whether the beneficiary is covered by Medicare as a result of retirement or as a result of a disability.
If a Medicare beneficiary is over age 65, and the beneficiary's spouse is employed and is covered by an employer-sponsored group health insurance policy, Medicare generally becomes the beneficiary's secondary insurer whenever the spouse's company has more than 20 full-time employees. In that case, the spouse's employer-sponsored group health insurance policy represents the Medicare beneficiary's primary insurer. However, if the spouse's company has less than 20 full-time employees, Medicare generally represents the beneficiary's primary insurer.
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